Abstract

Background

Tubal surgery is a widely accepted treatment for tubal infertility. Estimated livebirth rates after surgery range from 9% for women with severe tubal disease to 69% for those with mild disease, however, its effectiveness has not been rigorously evaluated in comparison with other treatments such as in vitro fertilisation (IVF) and expectant management (no treatment). Livebirth rates have not been adequately assessed in relation to the severity of tubal damage. It is important to determine the effectiveness of surgery against other treatment options in women with tubal infertility because of concerns about adverse outcomes, intra-operative complications and the costs associated with tubal surgery.

Objectives

The aim of this review was to determine whether surgery improves the probability of livebirth compared with expectant management or IVF in the context of tubal infertility (regardless of grade of severity).

Search methods

We searched the Cochrane Menstrual Disorders and Subfertility Group's trials register (searched August 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue, 2007), MEDLINE (1970 to August 2007), EMBASE (1985 to August 2007) and reference lists of articles. We also handsearched relevant conference proceedings and contacted researchers in the field.

Selection criteria

Only randomised controlled trials were considered eligible, with livebirth rate per woman as the primary outcome of interest.

Data collection and analysis

Two review authors independently assessed eligibility and quality of trials.

Main results

No suitable randomised controlled trials were identified.

Authors' conclusions

Any effect of tubal surgery relative to expectant management and IVF in terms of livebirth rates for women with tubal infertility remains unknown. Large trials with adequate power are warranted to establish the effectiveness of surgery in these women. Future trials should not only report livebirth rates per woman, but also compare adverse effects and costs of the treatments as outcomes. Factors that have a major effect on these outcomes, such as fertility treatment, female partner's age, duration of infertility, and previous pregnancy history should be considered. Livebirth rates in relation to the severity of tubal damage, and different techniques used for tubal repair including microsurgery and laparoscopic methods should also be reported.

Plain language summary

The effectiveness of fallopian tube surgery to overcome infertility caused by tubal disease cannot be determined at present.

Tubal surgery to overcome infertility caused by tubal disease is becoming popular due to the success rates (livebirths), advances in surgical techniques. including microsurgery, and because of the adverse outcomes and costs related to in vitro fertilisation (IVF), which is another option for overcoming tubal infertility. Tubal surgery, however, is also expensive; it requires additional specialist training for gynaecologists, experience to perform, and can have adverse effects (including ectopic pregnancies), and operative risks. Waiting to become pregnant without treatment (expectant management) is another option for women with tubal infertility. This review could not identify any clinical trials that compared tubal surgery with either IVF or expectant management. The authors conclude that at present the available research is not adequate to determine the effectiveness, or otherwise, of tubal surgery compared to either IVF or expectant management. More research is needed, including information about adverse outcomes and costs.